Bisphosphonate therapy for osteoporosis: combining optimal fracture risk reduction with patient preference

Objective: To review current use of bisphosphonates as first-line therapy for osteoporosis, with an emphasis on the importance of patient compliance and persistence. Methods: The US National Library of Medicine was used to obtain the relevant information on current bisphosphonate treatment for osteoporosis management, and patient compliance and persistence with treatment. Results: Bisphosphonates have demonstrated efficacy in fracture risk reduction, although differences may exist with respect to both onset of action and the site of fracture risk reduction. Good compliance and persistence with osteoporosis therapy is needed to reduce fracture risk, but currently the willingness of patients to conform to their prescribed course of treatment is suboptimal. Intermittent dosing schedules have been developed to facilitate ease of medication-taking in order to help improve rates of compliance and persistence. When primary care physicians provide patients with information about the established efficacy and safety of medications, as well as clarifying the crucial link between continued, consistent treatment and fracture risk reduction, patients are more likely to understand the importance of taking their medications consistently in order to maximize the effectiveness of the therapy. Conclusions: A therapy that provides vertebral and nonvertebral efficacy, is well-tolerated, and offers a flexible dosing regimen is likely to enhance patient compliance and persistence, and provide optimal fracture protection. Numerous studies have consistently demonstrated that medication compliance and persistence are well-correlated with fracture risk reduction.